BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.81.304 pertaining to Big Sky Rx premium change

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

            1. On December 30, 2019, at 1:00 p.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of the above-stated rule.

 

2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact the Department of Public Health and Human Services no later than 5:00 p.m. on December 23, 2019, to advise us of the nature of the accommodation that you need. Please contact Gwen Knight, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

 

3. The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:

 

            37.81.304 AMOUNT OF THE BIG SKY RX BENEFIT (1) An applicant eligible for the Big Sky Rx PDP premium assistance may receive a benefit not to exceed $35.80 $35.40 per month. The benefit amount will not exceed $35.80 $35.40 regardless of the cost of the premium for the PDP the individual chooses.

            (a) If a portion of the applicant's PDP premium is paid through the Extra Help Program, the Big Sky Rx Program will pay the applicant's portion of the PDP premium up to $35.80 $35.40 per month.

            (b) remains the same.

            (c) All expenditures are contingent on legislative appropriation. The amount of the monthly benefit, $35.80 $35.40, extends the Social Security Extra Help benefit amount to Montana residents with income up to 200% FPL. The department's total expenditure for the program will be based on appropriation and the number of enrolled applicants.

 

AUTH:  53-2-201, 53-6-1004, MCA

IMP:  53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA

 

            4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (department) is proposing to amend ARM 37.81.304.

 

The Big Sky Rx program contributes to the cost of an eligible Montana resident's premium payment in a federally approved Medicare Prescription Drug Plan (PDP). This rule proposal, if adopted, will decrease the maximum amount that Big Sky Rx will contribute to pay the eligible enrollee's monthly premium for a PDP program from $35.80 per month to $35.40 per month. The department is proposing this change in order to match the federally established Low Income Subsidy (LIS) monthly benefit benchmark, which is established each year by the Centers for Medicare and Medicaid Services posted at: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/RegionalRatesBenchmarks2020.pdf.

 

These proposed amendments are necessary to ensure the monthly benefit does not exceed the federal LIS benefit set for this region, rounded to the nearest 5 cents. Since the inception of Big Sky Rx, the benefit has mirrored the LIS premium benefit benchmark to ensure a reasonable and prudent monthly benefit for enrolled members.

 

Fiscal Impact

 

The rule proposal will affect 2,894 Montanans, who will see a 40-cent decrease in the amount of monetary assistance from Big Sky Rx for their monthly PDP premium. The rule proposal will decrease state special fund spending by $1,157.60 per month or $13,891.20 on an annual basis.

 

The department proposes that these changes become effective upon publication of the final rule notice.

 

            5. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Gwen Knight, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail dphhslegal@mt.gov, and must be received no later than 5:00 p.m., January 3, 2020.

 

6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

7. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency.  Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 5 above or may be made by completing a request form at any rules hearing held by the department.

 

8. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.

 

9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rule will not significantly and directly impact small businesses.

 

 

/s/ Brenda K. Elias                                       /s/ Shelia Hogan                             

Brenda K. Elias                                            Sheila Hogan, Director

Rule Reviewer                                              Public Health and Human Services

 

 

Certified to the Secretary of State November 26, 2019.